Evaluating the Ability of a Trauma Team Activation Tool to Identify Severe Injury: a Multicentre Cohort Study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2018 Aug 12

PMID 30097047

Citations 9

Authors

Ole-Petter Vinjevoll

Oddvar Uleberg

Elaine Cole

Affiliations

Soon will be listed here.

Abstract

Background: Sensitive decision making tools should assist prehospital personnel in the triage of injured patients, identifying those who require immediate lifesaving interventions and safely reducing unnecessary under- and overtriage. In 2014 a new trauma team activation (TTA) tool was implemented in Central Norway. The overall objective of this study was to evaluate the ability of the new TTA tool to identify severe injury.

Methods: This was a multi-center observational cohort study with retrospective data analysis. All patients received by trauma teams at seven hospitals in Central Norway between 01.01.2015 to 31.12.2015 were included. Severe injury was defined as Injury Severity Score (ISS) > 15. Overtriage was defined as the rate of patients with TTA and ISS < 15, whilst patients with TTA and ISS > 15 were defined as correctly triaged.

Results: A total of 1141 patients were identified, of which 998 were eligible for triage criteria analysis. Median age was 35 years (IQR 20-58) and the male proportion was 67%. Mechanism of injury was predominantly blunt trauma (96%) with transport related accidents (62%) followed by falls (22%) the most common. Overall, median injury severity score (ISS) was low and severely injured patients (ISS > 15) comprised 13% of the cohort. Utility of specific TTA criteria were: physiology 20%, anatomical injury 21%, mechanism of injury (MOI) 53% and special causes 6%. Overtriage among all patients was 87%, and for those with physiologic criteria 66%, anatomical injury 82%, mechanism of injury 97% and special causes criteria 92%, respectively.

Conclusions: Severe injury was infrequent and there was a substantial rate of overtriage. The ability of the TTA tool was relatively insensitive in identifying severe injury, but showed increased performance when utilizing physiologic and anatomical injury criteria. Many of the TTA mechanism of injury criteria might be considered for removal from the triage tool due to substantial rates of overtriage. This has relevance for the proposed development of national Norwegian TTA criteria.

Citing Articles

Adherence to national trauma triage criteria in Norway: a cross-sectional study.

Hoas E, Majeed W, Roise O, Uleberg O Scand J Trauma Resusc Emerg Med. 2024; 32(1):133.

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Feasibility and diagnostic accuracy of fast whole-body MRI in slightly to moderately injured trauma patients.

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Trauma triage criteria as predictors of severe injury - a Swedish multicenter cohort study.

Holmberg L, Mani K, Thorbjornsen K, Wanhainen A, Andreasson H, Juhlin C BMC Emerg Med. 2022; 22(1):40.

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Isolated vehicle rollover is not an independent predictor of trauma injury severity.

Moriarty S, Brown N, Waller M, Chu K J Am Coll Emerg Physicians Open. 2021; 2(4):e12470.

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